1. Moneke, Ngozi DHA, MSN, RN, ANP, CCRN-CMC
  2. Umeh, Ogwo J. PhD, MBA

Article Content

Critical care nurses' job satisfaction affects patient safety, productivity, quality of care, retention, and commitment to the organization and the profession. Likewise, poor nurse satisfaction leads to negative consequences, such as overwhelming workloads, and rising expenses associated with replacing nurses who leave their jobs and the profession.1-5

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Managers' behaviors are major components that increase overall job satisfaction and affect the work climate, which in turn impacts financial results.6-9 Replacing a nurse is costly, so increasing critical care nurses' job satisfaction is beneficial to organizations. One way to improve leadership effectiveness is for organizations to implement development programs that enhance leadership effectiveness. Healthcare organizations can contribute to nurses' overall professional development by identifying organizational activities that increase job satisfaction and implement strategies that attract, recognize, and retain the best critical care nurses.


Study methodology

The purpose of this study was to explore the influence of managerial leadership on job satisfaction of critical care nurses. Inclusion criteria were intensive care nurses in the medical intensive care unit (MICU), cardiac care unit (CCU), cardiothoracic intensive care unit(CTICU), surgical ICU, neuroscience unit and burn unit, who work either full time, part time, or on a per diem basis and have been employed by the organization for a minimum of 6 months. In total, 204 critical care nurses, excluding 52 invitations that were returned undelivered, from one United States-based, nonprofit healthcare organization, were invited to participate in the study. Out of the 204 who were invited, 137 critical care nurses voluntarily participated in the study, resulting in a response rate of 67%. Of the 137 who responded, 82% (112) completed the survey in its entirety and were used for the data analysis.


The nurses participated in the study by accessing a website that linked them to an informed-consent page and then to the 65-item survey and a demographic questionnaire. Using the Leadership Practices Inventory (LPI), five leadership practices were measured: enabling others to act (EOA), encouraging the heart (ETH), inspiring a shared vision (ISV), challenging the process (CTP), and modeling the way (MTW).11


Null Hypothesis: There will be no relationship between leadership practices and overall job satisfaction of critical care nurses. To test the hypothesis, quantitative technique was employed by incorporating Pearson product-moment correlation technique. The Cronbach's alpha for MTW, ISV, CTP, EOA, and ETH were between .91-.95, and job satisfaction was .87. Therefore, all the scales have good internal consistency.

Table Study findings... - Click to enlarge in new windowTable Study findings: Sample demographic characteristics

Study results

All completed responses were usable. Critical care nurses' demographic variables included age, gender, ethnicity, specialty certification, educational level, years with current employer, specialty area, title, shift, and employment status. Of those who answered the demographic questions; 85 (77%) were women and 25 (23%) were men; the largest age distribution of participants (40.8%) was between the ages of 29 and 38. (See Study findings: Sample demographic characteristics.)


Based on the data collected and statistical analysis, we found that job satisfaction is positively and significantly correlated with several perceived leadership practices: leaders who model the way, leaders who inspire a shared vision, and leaders who enable others to act. The analysis of the data also revealed a weak significant correlation between job satisfaction and leaders who challenge the process. Encouraging the heart wasn't significantly correlated with job satisfaction.


Implications for nurse leaders

This study suggests that the top perceived leadership practices that influence critical care nurses' overall job satisfaction in a nonprofit organization in New York City are model the way, inspire a shared vision, challenge the process, and enable others to act.


"Model the way" encompasses role modeling, accountability, reliability, perception and sensitivity, commitment to basic beliefs, and demonstration of transparency. Leaders should establish patterns of interaction that help their direct reports work collaboratively to achieve sustainable, positive outcomes. Exemplary leaders model the way by making explicit that there are no gaps between "what they say they do and their explanations for their actions" and "what they actually do and the real reasons for their actions."10


"Inspire a shared vision" reflects the nurses' passionate beliefs about the difference their leaders can make. It encompasses technical ability, vision, excitement, persuasion, strategy, and passion. This type of leadership practice encourages direct reports to achieve a high performance, speaks of trends that affect future performance, appeals to staff to share their dream of the future, and paints a "big picture" of the nurses' aspirations. Leaders can only inspire commitment; they can't command it. For a leader to gain support, he or she must have knowledge of the goals and values of his or her direct reports.11


"Challenge the process" entails the search for opportunities to change the status quo. In addition, it encompasses adventure, encouragement, intellectual curiosity, goal orientation, provocative encouragement, innovation, and risk taking. The leader challenges the process by exhibiting adventurous behavior, seeking challenging opportunities to test the skills of direct reports, and challenging them to try new approaches. The leader searches outside of the organization for new trends and innovative approaches to improve. He or she exhibits intellectual curiosity by asking "What can we learn?" and ensures that the organizational goals, plans, and strategies are met. He or she experiments and takes risks. Leaders must be committed to change and should support their direct reports as they deal with challenging situations.11


"Enable others to act" means building spirited teams. Leaders enable their direct reports to act by building trust, fostering collaborative relationships, and listening actively to differing points of view. Leaders enable others to act by showing empathy, treating others with respect and dignity, being supportive of the decisions others make, and building consensus by giving others choices about how to do their work, which ensures job growth. When nurses are trusted, have more discretion and authority, and are provided with more information, the outcome brings extraordinary results.11 Effective leadership also involves being aware of others' self-perceptions.12


Leadership matters

The findings of this study suggest that leadership behaviors are a primary factor in determining job satisfaction. To address the nursing shortage, hospital leaders must implement strategies to improve job satisfaction to retain critical care nurses. The complexities of interpersonal relationships within the clinical environment and the critical issues that nurses face on a daily basis indicate that morale, job satisfaction, and motivation are essential components of improving workplace efficiency, output, and communication among staff.13 Nurse leaders and healthcare administrators may want to use the results of this study to implement strategies that decrease critical care nurse turnover costs and improve patient safety and satisfaction.



Even though the current study focused primarily on critical care nurses who practice in a non-profit healthcare organization in New York City, it will not lay any claim to being a one-stop shop for all organizations across the U.S. Thus, the proposition that the findings of this study will be applicable to critical care nurses in all healthcare organizations in the U.S should be tested by other researchers. One recommendation would to conduct a research study using the same questionnaire but with a sample from a profit and not-for-profit healthcare organization. Information from this type of a study might determine if there's a difference in perception of leadership practices and job satisfaction of critical care nurses in these two different types of healthcare organizations.




1. Murrells T, Robinson S, Griffiths P. Job satisfaction trends during nurses' early career. BMC Nurs. 2008;7:7. [Context Link]


2. Pillay R. Work satisfaction of professional nurses in South Africa: a comparative analysis of the public and private sectors. Hum Resour Health. 2009;7:15.


3. Leurer MD, Donnelly G, Domm E. Nurse retention strategies: advice from experienced registered nurses. J Health Organ Manag. 2007;21(3):307-319.


4. Bliss WG. Cost of employees' turnover.


5. Buerhaus P, Potter V, Staiger DO, Auerbach DI. The Future of the Nursing Workforce in the United States: Data, Trends and Implications. Boston, MA: Jones and Bartlett; 2009. [Context Link]


6. Pittman J. Registered nurse job satisfaction and collective bargaining unit membership status. J Nurs Adm. 2007;37(10):471-476. [Context Link]


7. Institute of Medicine. A Summary of the February 2010 Forum on the Future of Nursing: Education. Washington, DC: The National Academic Press; 2010.


8. Goleman D. Leadership that gets results. Harv Bus Rev. 2000;78(2):78-90.


9. Veldhoven M. Financial performance and the long-term link with HR practices, work practices, and job stress. Human Resour Manag. 2005;15(4):30-53. [Context Link]


10. Robinson V, Lai MK. Practitioner Research for Educators: A Guide to Improving Classrooms and Schools. Thousand Oaks, CA: Corwin Press, Inc.; 2006. [Context Link]


11. Posner BZ, Kouzes JM.The Five Practices of Exemplary Leadership. San Francisco, CA: Pfeiffer; 2005. [Context Link]


12. Goffe R, Jones G. Why Should Anyone Be Led By You? Boston, MA: Harvard Business School Press; 2006. [Context Link]


13. Stapleton P, Henderson A, Creedy DK, et al. Boosting morale and improving performance in the nursing setting. J Nurs Manag. 2007;15(8):811-816. [Context Link]